MORNINGSIDE DAY OUT, Inc. FALL REGISTRATION FORM - 2015/2016 Application Date ___________________ Child’s Age on 9/1/2015 __________________ Student’s Name ____________________________________________________________ Birth date __________________ Age ____________ Gender___________ Street Address ____________________________________________________________ City ____________________________________ State _________ Zip ____________ Home Phone __________________ Preferred Email _____________________________ Parent’s Name _____________________________________________________________ Cell Phone ____________________________ Work Phone ______________________ Parent’s Name _____________________________________________________________ Cell Phone ____________________________ Work Phone ______________________ Emergency Contact ________________________ Relationship ______________________ Home Phone ___________________________ Cell Phone _______________________ Allergies or health concerns ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Any other information you would like us to have concerning your child ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ MORNINGSIDE DAY OUT, Inc. TUITION AND FEES: Registration Fee*- (due with application) $135 Activity/Supply Fee - (due September 1) Tuition - May Escrow* - (due September 1) (due upon acceptance) Babies: $110 2 & 3s: $170 4s & Pre : $185 5 days $450 4 days $380 (M,T,Th,F) 3 days $315 (M,W,F) 2 days $230 (T,Th) 1 day $120 One month’s tuition CLASS SCHEDULE: Circle your choice of days. Babies (6 -16 months) 1 or 2 days/ your choice M T W Th F 1st choice M T W Th F 2nd choice Spring 2s: (turning 2 between March 1 - Aug 30, 2016) T,Th or M,W,F Fall 2s: (turning 3 between Sept 1, 2015 - Feb 28, 2016) T,Th or M,W,F Spring 3s: (turning 3 between March 1 - Aug 30, 2016) T,Th or M,W,F Fall 3s: (turning 3 between Sept 1, 2015 - Feb 28, 2016) T,Th or M,W,F Young 4s: (turning 4 after September 1, 2015) 4 or 5 days Pre K: (turning 4 before September 1, 2015) 4 or 5 days Please submit Registration Form and Payment * to: MDO, P.O. Box 8986, Atlanta, GA 31106 * The $135 registration fee is non-refundable. Upon acceptance, one month's tuition is due, and will be credited towards the following May tuition payment. This payment is refunded ONLY under BOTH of the following conditions: 1) the family moves more than 25 miles from MDO AND 2) thirty (30) days written notice of withdrawal is given to the director. Refund remains at the discretion of the director. Parent Signature ________________________________________ Date ___________________